View full sizePeggy Turbett l Plain Dealer fileCleveland looks to be in line with New York City in getting tougher on certain vices. Just this week, New York Mayor Michael Bloomberg enacted a smoking ban in parks and on city beaches that will take effect by summer. In 2008, that city became the nation's first to ban artery-clogging trans fats at restaurants.

CLEVELAND, Ohio — In an unprecedented collaboration, the city of Cleveland and the county's four main health care institutions, are putting in place a plan to spur Clevelanders to become more healthy and fit.

The far-ranging approach, called "Healthy Cleveland," includes smoking cessation (and further restrictions on where people can smoke), diet and nutrition (removing sugar-based drinks and trans-fat foods out of machines in city-owned and run buildings), the promotion of mobility and exercise in neighborhoods, and changes in behavioral health.

The resolution will be introduced at Monday's City Council meeting, after several months of work that included the support of leaders from the Cleveland Clinic, University Hospitals-Case Medical Center, MetroHealth and the Sisters of Charity Hospital System.

Last October, Cleveland Clinic Chief Executive Officer Toby Cosgrove talked to Jackson about the city taking the helm in a comprehensive effort to get Cleveland healthier.

"I am more than happy to aid, assist and promote, but essentially it is not my leadership, but the city's. They are the umbrella," said Cosgrove in an interview last week.

The bottom line, he said, is that the major factors that contribute to the chronic diseases pervasive in this region, and to morbidity, "are inactivity, obesity and smoking."

"We've done a lot within our own four walls," he said, "but it needs to be led on a citywide basis, and we needed a buy-in from the mayor."

"The question became," said Mayor Frank Jackson in an interview on Friday, "how can we deal with Clevelanders' health in a positive, holistic way, in which we can get practical outcomes?"

"The answer was, 'Let's make it a broad community thing,'... rather than telling people 'This is what you have to do.' "

Jackson added, "Everyone agrees that having a healthier population is good not just for individuals, families and the community, but in a personal and financial sense. We want to create a culture and lifestyle of health.

"As these discussions unfold, we believe council and the public will draw the same conclusions."

Cosgrove said that what the Clinic has learned from its own initiatives -- rigorous smoking bans and not hiring smokers; subsidizing employee workouts; taking sugary foods out of the cafeterias -- is that "over time, you can make a difference. We are not going to be able to deal with the cost of health care in the U.S. unless we deal with these issues, and it has to be a multi-pronged approach."

After Cosgrove and Jackson met in October, the mayor enlisted Councilman Joe Cimperman, who heads council's public health committee, to work on the details.

"This is the first time everyone is coming together -- the major four health systems in the city, all using their expertise in a way that we can actually make the city of Cleveland healthier," said Cimperman. "To an institution, they were all on board, no ego -- people working together like this, I haven't seen."

"We can change the path of people's lives, through encouragement and enforcement," he added.

Cimperman said he anticipates the resolution will spawn at least 10 pieces of legislation, which will be taken up by various committees, including his own, over the next few months. Hearings will begin March 10, with local medical experts testifying.

Some of the items the resolution includes:

• Encouraging local restaurants and vendors to remove trans-fat items from their menus.

• Reincorporating school gardens at Cleveland schools.

• Ensuring that all new school buildings, or rehabbed buildings, have adequate kitchen facilities for the preparation of food.

Cleveland looks to be in line with New York City in getting tougher on certain vices. Just this week, New York Mayor Michael Bloomberg enacted a smoking ban in parks and on city beaches that will take effect by summer. In 2008, that city became the nation's first to ban artery-clogging trans fats at restaurants.

Cleveland was the first city in the U.S. to create zoning for farm gardens, Cimperman said, and first to provide incentives for companies doing business with the city to buy food from local sources. "Since January 1, every farmer's market started accepting food stamps," he said.

Jackson credited Cimperman's leadership on the Healthy Cleveland resolution. "Everyone agrees with the concept that we need to be healthier, but there was no coordination of these beliefs. He asked the institutions to be part of this, and they said yes."

What Dr. Eric Bieber, chief medical officer at UH, likes about resolution is that it will make it easier for people to do what's right.

" If something's not available, you can't make the choice -- say, for a nice cold apple -- whereas if you have more healthy options, you can.

"As a city, we're being proactive," he said, "and that's exciting for us to be part of the health of the community, one step at a time, in increments that people can tolerate and not be mad about."

"I think there are all kinds of great things that can happen here," said Cosgrove. "It will put the city on the map as a healthy place."

Can and will people change their behavior to make healthier choices? A look at smoking seems to show it can happen.

Adult cigarette use in Cuyahoga County is at a historic low, just a few years after a variety of smoking bans were phased in. The county's 15-percent usage rate is now the lowest in the state, besting Ohio's 20.3 percent rate.

"If you make people do something, they try to sneak around it. If they buy into it, they'll do it," said Jackson.

"We want to get to a point where ... healthier ways become a way of life in Cleveland. If we are successful in implementing this, people will use Cleveland as their model."

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